HIPAA 101

HIPAA provides a variety of protections for health care consumers which were a break-through for working people with a health condition. A general description of each of the protections follows. Information about each protection is in other sections of this article.

As you read about the protections, keep in mind that because of the Affordable Care Act (sometimes referred to as "Obamacare"), the provisions which eliminated job lock for people with a health condition or health history are no longer as important to your life as they once were. Under the Affordable Care Act, you cannot be denied health insurance because of your current or historic health condition.

Employer group coverage: Guarantee of coverage; right to convert

• HIPAA applies to all employers with two or more employees which offer health insurance to people in a position similar to yours.
• HIPAA does not guarantee that an employer will offer health insurance in general, or with respect to your job. However, if you become eligible for group health insurance because of your job, you cannot be refused coverage because of a medical condition or medical history.
• HIPAA guarantees the right to convert your employer based health insurance to individual coverage if the group coverage ends (including at the end of COBRA). For information, click here.

Job Lock (preventing employees from moving from one job to another because of fear of losing health insurance due to an existing health condition)

HIPAA protects against job lock in two ways:

• Limitation on amount of time an employee is not covered by health insurance
  • HIPAA limits the amount of time an employer may postpone coverage for a pre-existeing health conditon to 12 months if you sign up for the group coverage as soon as you are eligible.If you delay enrolling, the employer can impose a waiting period of up to 18 months.
• If there is no more than a 62 day gap between coverages, you can offset the number of months you previously had creditable health insurance against the new pre-existing condition exclusion period.
• By providing a credit for existing "Creditable Coverage" against the period of time during which pre-existing conditions are not covered under a new employer's coverage. Click on the following links for information about: Creditable health insurance (what it is; how to prove; how to get a certificate etc.)  Pre-existing health condition
• During the waiting period, any other health claims you have will be covered.
• NOTE: 
  • If you are considering changing jobs, see: Should I Change Jobs? 
  • HIPAA could be thought of as the sister law to the provisions of the Americans With Disabilities Act (ADA) which protect other aspects of employment, For instance, the prohibits new employers asking about prospective employees' health condition.
  • Also see: New Hire: If Health Questions Are Asked On The Health Insurance Enrollment Form.

Individual health coverage cannot be cancelled due to health conditions

• HIPAA provides that your individual health insurance cannot be cancelled because you become ill or because of your health status. Still, keep in mind that your health coverage can be canceled if you: do not pay the premiums. move out of the area served by your health plan and/or commit fraud - such as lying on an application.

Privacy About Medical Information; Your Right To See And Copy Medical Records

• HIPAA provides a minimum national standard of privacy with respect to your medical information. HIPAA also gives you a right to see and copy your medical records. To learn more, click here.

Enforcement

• HIPAA is enforced by the government, not by individuals. HIPAA authorizes Health and Human Services (HHS) or the U.S. Department Of Justice to enforce the law. For information about filing a complaint with the federal government, click here .

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